Dr Ellen TothDr Ellen Toth

University of Alberta University of Alberta

Standing Strong against DiabetesMaskwacis Health Services Diabetes Conference,

November 2012

Standing Strong against DiabetesMaskwacis Health Services Diabetes Conference,

November 2012

Maskwacis Diabetes Health Conference 2012, E. Toth

Plan for today

Introduction

What is diabetes

Standing Strong

Maskwacis Diabetes Health Conference 2012, E. Toth

Dr Ellen Toth Department of Medicine University of Alberta – Diabetes specialist

Doing clinics in Hobbema monthly.. every 2 weeks…. for 10 years

Because there is a lot of diabetes in Hobbema

Because it is not easy for people from Hobbema to get access to good diabetes or other Health Care

Maskwacis Diabetes Health Conference 2012, E. Toth

Dr Ellen Toth BRAID Research: www.braiddm.ca

Since 1999: “diabetes epidemic in aboriginals”

main focus of work

SLICK/CHIPP in 2001,

ACADRE in 2002

MDSi

in 2003

BRAID since 2002, BRAID kids 2008

CIRCLE in 2009

ADSS

Present grants:

Pregnancy barriers (Richard Oster)

Self determination / cultural continuity (Richard Oster and Davida

Reingold)

Type 2 diabetes in kids (Davida

Reingold

and Kelli Ralph Campbell)

Diabetes and Pregnancy in Hobbema (Lawson Foundation)Maskwacis Diabetes Health Conference 2012, E. Toth

Dr Ellen Toth Other activities and anxieties

Medical Lead for Aboriginal Health –

Aboriginal Health Program –

Capital Health / AHS /North / Edmonton Zone,

Medical Director: Aboriginal Diabetes Wellness Program / Aboriginal Wellness Program

GRUMP!

We are NOT winning…

well…

maybe?????

Diabetes epidemic

Pregnancy complicating diabetes

Mental Health: effects of residential school.

Maskwacis Diabetes Health Conference 2012, E. Toth

ADSS 2009

Authors: Oster, Hemmelgarn, Toth, King, Crowshoe, Campbell

Rates of high risk pregnancies

Diabetes and high risk pregnancies

Plan for today

Introduction

What is diabetes

Standing Strong

Maskwacis Diabetes Health Conference 2012, E. Toth

What is Diabetes?• A condition where the sugar in the blood is too high

• A common problem all over the world (1% to 50%)

• A chronic condition with no cure

• A condition that can be managed

• Several types and several “complications”

Maskwacis Diabetes Health Conference 2012, E. Toth

Newoyaw: Life map for Living with Diabetes

Newo = 4Miyaw = BodyNewoyaw = 4 Bodies

MindBodySpiritEmotion

ACKNOWLEDGEMENT:Aboriginal Diabetes Wellness Program

How does it happen? What happens when we eat?

Food that we eat turns into sugar to be used as energy

Food Sugar Energy

= =

What happens when we eat?

Wood = Sugar Fire-Keeper = Insulin Teepee = Cell

The Fire-Keeper (Insulin) brings the wood (Sugar) into the Teepee (Cell) to make a fire that produces heat and energy

What happens when we eat?

Wood = Blood Sugar

•Blood sugar comes from the food we eat

Fire-Keeper = Insulin•Insulin brings the blood sugar into the cells•Insulin is made by the pancreas

What happens when we eat?

Teepee = Body CellFire = Energy

•The body’s cells use the sugar as energy

Why does it happen? What is Type 2 Diabetes?

Leaky Liver: Too much sugar:

Pooped out Pancreas: Not enough or Insulin too tired

Cell Resistance:Insulin unable to bring sugar into the cell

When we have diabetes several things are going on: - our bodies can release too much sugar- our insulin is not working properly - our cells resist insulin

What is Type 2 Diabetes?Leaky LiverThe liver leaks too much sugar. Blood sugars rise

Pooped out PancreasThe pancreas is not making enough insulin. Or the insulin is too tired and not able to work properly. Blood sugars rise.

Cell ResistanceThe cells don’t allow insulin to bring the sugars into the cell. Blood sugars rise.

Maskwacis Diabetes Health Conference 2012, E. Toth

What is Type 2 Diabetes? How can it be managed?Leaky LiverThe liver leaks too much sugar. Blood sugars rise

Pooped out PancreasThe pancreas is not making enough insulin. Or the insulin is too tired and not able to work properly. Blood sugars rise.

Cell ResistanceThe cells don’t allow insulin to bring the sugars into the cell. Blood sugars rise.

Lifestyle Lifestyle

Pills, mainly metformin

Lifestyle

Pills, diabeta, diamicron, gluconorm, januvia

Pills, mainly metformin

Insulin, the needle

Insulin, the needle

Insulin, the needle

Maskwacis Diabetes Health Conference 2012, E. Toth

Other types of diabetes

Type I Gestational Prediabetes

Also secondary diabetes, eg to pancreatitisMaskwacis Diabetes Health Conference 2012, E. Toth

Type 1 Diabetes

Formerly known as juvenile-onset or insulin-dependent diabetes

Causes: Immune system damaging cells that make insulin; viruses and /or environmental

You need insulin injections for the rest of your life

Gestational Diabetes

Diabetes during pregnancy.

Causes: Hormones that help the baby develop can affect your own insulin's ability to handle sugar. This is a type of insulin resistance.

Both mother and child are at a higher risk of developing type 2 diabetes later in life.

Pre-Diabetes

< or = 6.0No diabetes

6.1 – 6.9Pre-diabetes

> or = 7.0Type 2 diabetes

Good! Take action! Diagnosis

Maskwacis Diabetes Health Conference 2012, E. Toth

Pre-Diabetes

Prediabetes can be slowed down or prevented by proper nutrition, exercise & weight loss. It is a life time commitment.

Medication can also help (metformin)

Plan for today

Introduction

What is diabetes

Stand Strong

Maskwacis Diabetes Health Conference 2012, E. Toth

How might communities stand strong?

Prevent diabetes, and pre-diabetes

Treat diabetes, and pre-diabetes

Live well with diabetes

Assess and treat diabetes complicating pregnancy

Maskwacis Diabetes Health Conference 2012, E. Toth

Type 2 Diabetes Risk Factors

Overweight / Obese / Inactive

Aboriginal, Hispanic, African, Asian

Family history of type 2diabetes

Age

Previous gestational diabetes

STRESS Modified from CDA, Toth

How might communities stand strong?

Personally Prevent diabetes

Residential school

Diabetes

Indian Act

Mental Health

Community Prevent diabetes

Plan pregnancies, test and treat diabetes in pregnancy

E. Toth, 2012

Social determinants of health

Family and friends

Community leadership

Self: genetics, health beliefs, self esteem, resources

Access to quality health care

What is needed for health?

Toth 2010Maskwacis Diabetes Health Conference 2012, E. Toth

Questions and discussionDr Ellen Toth: 780 - 407- 3636

Ellen.toth@ualberta.ca

www.braiddm.ca